This proposal is designed to provide Dr. Harwood with the training, research experience and analytic expertise to become a leader in contraceptive decision making research and a successful independent researcher in the field of family planning. In this proposal, Dr. Harwood will use an innovative interdisciplinary approach to study women's preferences for contraceptive characteristics and related health states, to compare their preferences to their current method of contraception, and to develop a decision support aid for contraceptive decisions related to intrauterine device (IUD) use. In the long term, optimizing contraceptive decision-making is integral to improving contraceptive use and reducing unintended pregnancies. Understanding contraceptive decision making will direct the development of interventions to provide decision support aimed at optimizing those decisions in order to help women and couples choose a method that they could use correctly and most effectively to avoid an unintended pregnancy. The University of Illinois at Chicago is the ideal environment for this proposal, with excellent research mentorship across disciplines (Public Health, Decision Science, Behavioral Science, and Medical Science), strong institutional support for research and academic career development, and a diverse patient population at risk for unintended pregnancy and its consequences. The specific aims of this project are to 1) apply the framework for Decisional Conflict to contraceptive decisions to identify the factors that influence or determine contraceptive decisions using qualitative methods, 2) assess and quantify patient preferences for contraceptive and lUD-related health states in women at risk of unintended pregnancy to predict and compare contraceptive decisions using utility assessment methods, and 3) design an individual decision support aid to optimize IUD decision making. The goal of this intervention is to optimize a patient decision and facilitate provider communication about lUDs. The long-term goal is to develop interventions to support all contraceptive decisions so they best fit with the desire to avoid pregnancy. Pregnancy is a health state most women experience, and while it is not a disease, it carries a significantly higher risk of illness or death than the non-pregnant state. Preventing unintended pregnancy improves reproductive health outcomes in all respects. This project will focus on the IUD because its underutilization in the U.S. makes it an appropriate method to investigate interventions to increase use and thereby decrease the unintended pregnancy rate. Increasing the use of highly effective methods such as the IUD will reduce the prevalence of unintended pregnancy in the U.S. and result in large improvements in reproductive outcomes, health care costs and quality of life for women and families.